Walking Through the Research Process Using...

Walking Through the Research Process Using Library Resources

Amy L Harper, MLIS Clinical Librarian Harborview Medical Center University of Washington, Seattle, WA [email protected]

Janet G Schnall, MS, AHIP Information Management Librarian Health Sciences Libraries University of Washington, Seattle, WA [email protected] Nursing Research Workshop

January 11, 2010

Objectives

• Describe the research process

• Describe the PICO question format

• Outline strategies for searching PubMed and CINAHL to find research articles

• Organize research using a citation manager

• Describe how to evaluate a research article and the levels of evidence

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What is Nursing Research?

• A systematic process of inquiry that uses rigorous guidelines to produce unbiased, trustworthy answers to questions about nursing practice.

Houser, J. (2008). Nursing research: Reading, using, and creating evidence. Sudbury, Mass: Jones and Bartlett Publishers.

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Research May Be Used To:

• Change nursing care processes

• Influence organizational policies and procedures

• Create or enhance patient care management tools

• Formulate more effective care decisions regarding individual patient needs

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Research Process

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Define a research problem/formulate

question

Find the evidence/literature

search

Analyze/Appraise evidence

Organize your research

Determine research design

Data collection/analysis

Publish/translate research into

practice

Research Process

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question


search






practice

Sources of Research Questions

• Clinical practice

• Educational experience

• Patient feedback

• Professional literature

• Performance improvement/QI

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Define Your Question

• #1: What type of question is it?

– Diagnosis

– Prognosis

– Therapy

– Prevention

– Education

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Refine Your Question

• #2: Create an answerable question using the PICO framework

P Patient or Problem

I Intervention, prognostic factor, exposure

C Comparison

O Outcomes

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PICO Example

Initial question: Is there an association between chocolate intake and heart failure in women?

Reformulated question: In middle-aged and elderly Swedish women, is chocolate intake associated with the risk of incident heart failure hospitalization or mortality?

PICO

PATIENT/PROBLEM – middle-aged and elderly Swedish women

INTERVENTION – chocolate intake

COMPARISON, IF ANY – no chocolate intake

OUTCOME – incident HF hospitalization or mortality

Understand Your Question

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• #3: Is this a background or foreground question?

• Background: General knowledge

– Ex: What causes hypertension?

– Ex: What therapies are commonly used to treat hypertension?

• Foreground: Specific knowledge that could directly inform clinical decisions

– Ex: Can a regular intake of chocolate high in favanol content lower blood pressure?

Research Process

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question


search






practice

Resources for Background Questions

• Reliable textbook – HealthLinks eBooks page: 1400+

healthlinks.washington.edu/textbooks

– HEAL-WA eBooks: 70+

heal-wa.org/ebooks

• UptoDate

– Online text with concise, comprehensive up-to-date reviews of clinical topics in multiple specialties

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h heal-wa.org

Resources for Foreground Questions

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• Search for evidence-based resources

• Search for primary research articles

Evidence Pyramid

CINAHL vs. PubMed

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CINAHL • Coverage: 1982+ • Indexes 1700 journals • Focuses on nursing and allied

health literature • CINAHL Thesaurus with more

nursing terms • Has peer-reviewed limit • Includes cited references at end

of many refs

PubMed • Coverage: late 1940’s+

• Indexes 5000 journals

• Focuses on biomedical literature

• Uses MeSH as its controlled vocabulary

• No peer-reviewed limit

• No cited references

CINAHL or [CINAHL Plus]

• Cumulative Index to Nursing and Allied Health Literature

• Provides coverage from 1982 [1937] to date, of nursing and 17 allied health disciplines literature

• 1700+ [3800+] journals indexed including virtually all English-language nursing journals

• Search with text words and thesaurus terms

• Can easily search for Research articles

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Enter search

terms

CINAHL Publication Type Limits

• Clinical trial

• Critical path

• Practice guidelines

• Research

• Standards

• Systematic review

PubMed

• MEDLINE (1940’s+) is included on PubMed

• Indexes 5,000 biomedical journals

• Covers all aspects of biosciences and healthcare

• 75%-80% of citations have abstracts

• Updated 5x/week

• Search with text words or MeSH (thesaurus) terms

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Enter search

terms

Ask your librarian for help

• Literature searching: your librarian can work with you to create a focused search

– Sometimes this takes several iterations because you will discover new information and ideas

– You may need to revise your research question

– You need to think critically about the search

Locating eJournals

• Check with your library for access to full-text eJournals

• UW Staff/Students: use the Proxy service to access full-text eJournals from off-campus

• Non-UW: use HEAL-WA.org

– Includes CINAHL and MEDLINE links to full-text articles

– A-Z Journals: 2,600 full-text journals

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• Evidence Summaries

Evidence Pyramid

Search for Evidence Summaries

• DynaMed

– Evidence-based clinical resource providing summaries of 3500+ diseases and conditions

• Nursing Reference Center

– Comprehensive point-of-care resource for nurses that includes Evidence-based Care Sheets

• Natural Standard

– Provides high quality, evidence-based information on herbs, vitamins, diets, complementary practices (modalities), and medical conditions

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DynaMed

• Provides summaries of the best evidence for over 3,500 clinical topics

• Can quickly browse and find key recommendations

• Updated daily

• Links out to full-text articles

• Download available for PDA and iPhones

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Nursing Reference Center

• Evidence-based summaries

– Diseases & Conditions

– Evidence-based Care Sheets

– Quick Lessons

– Information about drugs and medications

– Skills & Procedures

– Patient Education

– CE

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• Systematic Reviews

Evidence Pyramid

A Systematic review: is a literature review focused on a single question which tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question.

Meta-analyses: are systematic reviews that combine the results of several studies using quantitative statistics.

Systematic Reviews vs Meta-Analyses

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Cochrane Database of Systematic Reviews

• Widely regarded as the “gold standard” of evidence-based information

• Extensive systematic reviews and complex synthesis

• Very focused, specific questions

• Includes full-text reviews and protocols

• Cochrane Abstracts indexed in PubMed and CINAHL

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49

chocolate

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Authors' conclusions

There is insufficient evidence to confirm or refute the

effectiveness of caffeine avoidance on birthweight or

other pregnancy outcomes. There is a need to

conduct high-quality, double-blinded RCTs to

determine whether caffeine has any effect on

pregnancy outcome.

Research Process

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question


search






practice

How to Scan a Research Article

• First, read:

– TITLE, ABSTRACT, and INTRO

– Section and Sub-Section HEADINGS

– CONCLUSIONS

• Second, look at:

– Discussion

– References

– Graphs, tables

• Third, read entire article if interested in more details

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Appraising the Evidence Q’s

• Given my clinical question, what is the appropriate study design?

• Is this study (or review) valid?

• Are the results significant (important)?

– Number Needed to Treat (NNT)

• Are the patients in those studies similar to mine?

• Is the treatment setting similar to mine?

Steps to Appraising Evidence Resources

• Determine the level of evidence

• Use a critical appraisal guide

• Create a study evaluation table

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Levels and Grades of Evidence

REPROLINE, Johns Hopkins University www.reproline.jhu.edu 55

Appraisal Guides

• CEBM (Oxford) Critical Appraisal Sheets

– http://www.cebm.net/index.aspx?o=1913

• CEBM (Toronto) Critical Appraisal Worksheets

– http://ktclearinghouse.ca/cebm/practise/ca/worksheets

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Therapy: Critical Appraisal Sheet

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Create a study evaluation table

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Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Critical Appraisal of the Evidence: Part I. Am J Nurs. 2010 Jul;110(7):47-52.

Research Process

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question


search






practice

Use a Citation Manager

• Examples: RefWorks or EndNote

• Why should I use this?

– Save references

– Keep track of references and articles

– Create bibliographies quickly and easily

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Research Process

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question


search






practice

Determine Research Design

• Select a design appropriate for nature of the question

– Quantitative research

– Qualitative research

– Mixed methods: both quantitative and qualitative

• And the time dimension

– Retrospective study: uses secondary data already collected

– Prospective: conducted by researcher; real-time process to collect primary data for this study

– Longitudinal: conducted over time

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Research Process

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question


search






practice

Data Collection/Analysis

• Design a sampling plan detailing how subjects are recruited and assigned to groups, and how many needed

• Collect data with appropriate data collection protocols and reliable/valid methods: physiologic and psychometric; questionnaires; interviews; focus groups, observation, etc.

• Analyze and report data with techniques appropriate for type of data collected and that will answer the question:

e.g., statistical tests, standard error, bar chart, scatter plots, mean, median, etc.

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Research Process

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question


search






practice

Dissemination of Research

• Communicate your findings

• Conference presentations

• Posters

• Practice guidelines

• Publish! Publish! Publish!

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Translate Research into Practice

• Apply the findings to your clinical practice along with your clinical expertise and patient’s values and preferences

• Evaluate the outcomes of your practice decisions or changes based on evidence

• Melnyk BM, Fineout-Overholt E, et al. Evidence-based practice: step-by-step. 8 article series in American Journal of Nursing which overviews EBP for nursing. – http://journals.lww.com/ajnonline/pages/collectiondetails.aspx

TopicalCollectionId=10

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Additional Resources

• Tutorials – http://healthlinks.washington.edu/howto/cinahlplus/index

.pdf

– http://healthlinks.washington.edu/howto/pubmed/

– http://healthlinks.washington.edu/howto/connect/

• Resource for Non-UW – http://heal-wa.org/

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For more information…

• Affiliated with UW, contact the nursing library liaison: Janet G Schnall, MS,AHIP 206.543.7474 [email protected]

• At HMC, contact the HMC librarian: Amy Harper, MLIS 206.744.7744 [email protected]

• Or, contact your institution’s librarian

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Walking Through the Research Process Using Library Resources

PowerPoint presentation located: healthlinks.washington.edu/hsl/liaisons/harper/hmc2011.ppt

Walking Through the Research Process Using...

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